Well Child Assessment

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I need this essay to be rewritten; however, same format. The Child Development Assessment Revised 3 (4). docx

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Child’s initials: A. J., male, caucasian

Age: 11

Born: December 21st

57 inches tall, 78 lbs

3 siblings: 23 year old half brother, 21 year old half sister, 13 year old brother (biological)

Father is a Lieutenant Commander in the military. Father works 5 days a week, leaves at 6 in the morning, returns after 6pm. Father has strict rules, authoritarian household

Mother is a hairstylist. Works part-time. Arrives home to meet children at the bus.

Parent DO NOT SMOKE. The only strain on growth development is the parenting style: authoritarian.

Autocratic Leadership (Authoritarian) Leadership: Autocratic leaders make independent decisions without communicating, collaborating and consulting with others. These leaders state what has to be accomplished, when it must be done, and how it should be done. Families who use an autocratic or authoritarian parenting are typically strict and the leader has control and authority over the other family members. Some families that use the autocratic or authoritarian parenting style are considered patriarchal, with the father as the leader, and others are considered matriarchal with the mother as the person with the power and control over other members of the family.

Family dysfunction, as defined by the North American Nursing Diagnosis Association (NANDA), is the “psychosocial, spiritual, and physiological functions of the family unit are chronically disorganized , which leads to conflict, denial, of problems, resistance to change, ineffective problem solving, and a series of self perpetuating crises”.

Some of the many stressors and crises that can impact on the family unit include poverty, homelessness, abuse, neglect, substance related abuse including alcoholism, divorce, separation, psychological illness, maturational and developmental crises such as the birth of a new baby, role changes, power shifts, and physical illnesses.

Assessment Focus

  • Communication
  • Emotional
  • Coping
  • Roles/relationship

Expected Outcomes Family Members Will

  • Not experience physical, verbal, emotional, or sexual abuse.
  • Communicate clearly, honestly, consistently, and directly.
  • Establish clearly defined roles and equitable responsibilities.
  • Express understanding of rules and expectations.
  • Report the methods of problem solving and resolving conflicts have improved.
  • Report a decrease in the number and intensity of family crises
  • Seek ongoing treatment.

Suggested Noc Outcomes

Family Coping; Family Functioning; Family Normalization; Social Interaction Skills; Substance Addiction Consequences

Intervention And Rationales

Determine: Assess family’s developmental stage, roles, rules, socioeco-nomic status, health history, history of substance abuse; history of sex-ual abuse of spouse or children, problem-solving and decision-making 131 skills, and patterns of communication. Assessment information will provide development of appropriate interventions.Perform: Meet with family members to establish levels of authority and responsibility in the family. Understanding the family dynamics provides information about the kinds of support the family needs to work with the patient’s issues.Create an environment in which family members can expres themselves openly and honestly to build trust and self-esteem.Establish rules for communication during meetings with the family to assist family members to take responsibility for their own behavior.Inform: Teach family members basic communication skills to enable them to discuss issues in a positive way. Have them role-play with one another numerous times to demonstrate what has been learned.Involve the family in exercises to reduce stress and deal with anger.Attend: Hold adults accountable for their alcohol or substance abuse and have them sign a “Use contract” to decrease denial, increase trust, and promote positive change.Involve patient in planning and decision making. Having the ability to participate will encourage greater compliance with the plan.Assist family to set limits on abusive behaviors and have them sign “Abuse contracts” to foster feelings of safety and trust.Manage: Refer to case manager/social worker to ensure that a home assessment is done.Refer to support groups that deal with substance abuse, domestic violence, or sexual abuse depending on the needs of the patient and/or family to enhance interpersonal skills and strengthen the family unit.Provide all appropriate phone numbers so that the family members can initiate whatever follow-up is needed.

Suggested Nic Interventions

Coping Enhancement; Family Integrity Promotion; Family Process Maintenance; Family Support; Normalization Promotion; Substance Use Prevention; Substance Use Treatment

Reference

Yonaka, L., et al. (2007, January–February). Barriers to screening for domestic violence in the emergency department. Journal of Continuing Education for Nursing, 38(1), 37–45.

Theorists: Eric Erickson

Psychosocial Development of Middle Childhood

Erikson’s theory of industry versus inferiority explains the psychosocial development of middle childhood.

The energy of children during middle childhood development is directed towards creativity and productivity. They strive to accomplish competence at useful skills and tasks to attain social recognition among the adults and children in their environment.

SELF-ESTEEM DEVELOPMENT DURING MIDDLE CHILDHOOD

Self-esteem is based on how children perceive themselves in the areas that are important to them.

Healthy self-esteem is built on positive self-concept, which gets pronounced during middle childhood years.

From age 6 to10 are the early school years, when children establish their own identity. Individuality and independence is first experienced by children during this phase of development.

Self-esteem of middle childhood children is very high

They have high self-esteem; respect themselves and the family to which their own identity is linked. They begin to mark their own social stand in appearance, behavior and capabilities in comparison to those around them.

Their capabilities and social status influence their self-concept and consequently their self-esteem. At this stage of childhood development children judge themselves according to their ability to produce socially valued outputs.

Building healthy self-esteem is a continuous process. It starts in child’s own mind as a part of psychosocial development of middle childhood.

As children advance through school years, they associate their self-esteem in three separate facets; academic, social and body image.

Low self-esteem impairs school performance & social relationships

The danger of inadequate self-esteem development arises in children whose personality development has been hampered by early childhood trauma.

These children are usually poor achievers; they lack their basic self-esteem essential to build overall confident personality. They are likely to suffer from inferiority complex unless intervened early by positive reinforcement by parents and teachers.

PSYCHOSOCIAL DEVELOPMENT AND PARENT-CHILD RELATIONSHIP

The desire for independence and growing individuality move children into the world that is a little distant from that of their parents. They assert their will, defy authority and resist parental interference. This is often misinterpreted as disrespectful behavior.

Children however recognize the need for the parents’ support. They respect parents’ knowledge and skills and strive to seek parents’ acceptance. Emotional deprivement leaves them lonely and in pain. Co-regulation prevents social and emotional disharmony in children.

Emotional Deprivement Leaves Children Lonely & In Pain3Save

CO-REGULATION

Co-regulation implies that parent to child communication need to be a bilateral dynamic process rather than simple exchange of information. This form of child parenting is also known as democratic parenting.

Here the words and the tone of conversation are adjusted based on perceptions, facial expressions and body language of the child.

Since children get the liberty to express their views, they do not resist sharing information or avoid participating in a discussion.

Co-regulation helps parents to hold oversight and gives children the desired independence and the responsibility.

COPING WITH SIBLING RIVALRY

Sibling rivalry is a normal phenomena of psychosocial development of childhood. It is the reflection of competitive attitude of children to achieve recognition among the adults and children in their environment: Essential process for healthy self-esteem and personality development.

Siblings are companions, who help and comfort each other through difficult tasks and difficult times. Elder sibling usually attains higher IQ and better school grades as a result of parental expectation of mature behavior. The younger gains more peer popularity attributed to development of better negotiating and compromising capabilities.

COMPARISON PERPETUATES SIBLING RIVALRY

Comparison of siblings’ traits, abilities, and accomplishments by the parents leads to an increase in sibling rivalry and may even perpetuate jealousy between them.

When siblings are close in age and of the same sex, parental comparisons take place more frequently, which results in more quarrelling and antagonism among the siblings.

BUILDING PEER GROUP RELATIONSHIPS

Psychosocial development of middle childhood focuses on peer relationship. Children at this age conform readily to the peer group norms in order to win social acceptance. They seek acceptance both from elders and peer group by their ability to produce socially valued outputs.

Peer group provides a context in which children practice cooperation, leadership and followership, and develop a sense of loyalty to collective goals.

During middle childhood, friendships are fairly stable. Friends chosen tend to be of the same age, sex, and ethnicity.

JEAN PIAGET

Piaget – Concrete operations
Transitions from perceptual to conceptual thinking

Masters the concept of conservation

Conservation of mass is understood first, followed by weight, and then volume

Learns to tell time

Classifies more complex information

Able to see the perspective of others

Able to solve problems

Age appropriate activities for an 11 year old:

Competitive and cooperative play is predominant

simple board games and number games
hopscotch
jump rope
collections (rocks, stamps, cards, coins, or stuffed animals)
ride bikes
build simple models
join organized sports ( for skill building)

Age-appropriate activities for 9-12 years

make crafts
build models
collect things/ engage in hobbies
solve jigsaw puzzles
play board games and card games
join organized competitive sports

A.J. participates in Tae Kwon Do, he is a blue belt. He also plays soccer for recreations. He also loves anything related to automobiles.

Safety Concerns: guns are located inside the household. Bleach and harmful cleaning chemicals in accessible location. Recommend to lock guns in secure location and keep chemicals out of reach or stored in a locked compartment, or outside in the garage.

Information that can remain the same:

food diary, ADHD, nutrition

Factors that facilitate/inhibit G&D and Discussion of Identified Problems and pediatric home environment (except for smoking and drinking)

Discussion of identified problems

Discussion of identified problems

Child’s Home Environment

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